How well is telemedicine developed in India

Telemedicine : Cancer diagnosis from India

“Fresh ischemia on the right frontal. Vascular-ischemic lesions on both sides of the occipital area ”, the radiologist from the Berlin Charité speaks into a microphone. The words appear promptly on a monitor thanks to speech recognition software. The doctor never saw the patient.

He doesn't have to either. Radiology even works from thousands of kilometers away, thought the native Indian Biju Thomas Mathew, who works as a cardiologist at the Catholic Clinic Ruhr Area North. In 2010 he founded the company "Heidelberg Medical Consultancy" in India, which evaluates brain scans, X-rays and mammograms around the world. More than 100 Indian radiologists write the findings as freelancers.

Mathew is not alone with his business idea. Dozens of companies in Eastern Europe, China and India are searching for tumors and strokes in the pictures of patients from the US, Australia and Europe. And there are more and more. "Radiology has the chance to become the first global medicine," says the President of the German X-ray Society, Michael Forsting, and enthuses: This is an answer to the shortage of young people. Smaller clinics are already working together with larger hospitals in order to master the flood of images. At night and when sick leave is high, they send the recordings encrypted through the network. Some hospitals even use remote diagnosis around the clock, such as the foundation hospital in Nördlingen in Swabia and the Unterallgäu district clinic in Mindelheim. The teleradiologists are still in the next largest city. But in the future, the findings would come from abroad, Forsting is certain.

The remote diagnoses by the Charité radiologists save time and money

The Charité radiologists receive the images from the Dominikus Hospital and the Waldfriede Hospital in Berlin at night. Such teleradiological cooperation saves money and time, according to studies. The staff is thinned out. The physician Volker Stark comes to the conclusion that the Mindelheim district hospital saves almost 25 percent thanks to remote diagnosis per computer tomography.

Clinics in the US employ Indians and Chinese. Due to the time difference, they view the images taken at night during the day. The salaries of the Indian colleagues are only around a fifth of the US wages, says Mathew. But the results are at least as good.

Teleradiology companies like to advertise quality. "All diagnoses are checked again by another specialist before they are sent," says Dorota Galuszka, manager of the Prague-based Teleradiology Europe. Around 100 Czech radiologists prepare the findings for this company on a fee basis. Customers are clinics from Spain, the USA, Slovakia and Georgia. Michael Forsting has no doubts about the quality. Radiology is highly specialized and teleradiology companies can have the images evaluated by experts. “They recognize rare diseases that are otherwise overlooked. And the colleagues trained in eye diagnostics are much faster, ”he says.

Faster, better and cheaper - the President of the German X-ray Society doesn't like to find anything bad about remote diagnosis. The fact that the doctor treats an anonymous person is also not a problem. "Everything you need to know can be in a doctor's letter," says Forsting.

If there is a lack of essential information, there is a risk of incorrect information

However, quite a few radiologists disagree. “I think it's nonsense that teleradiological care is better,” complains Christian Bauknecht, a neuroradiologist at the Charité. In almost every night shift, the colleagues phone the teleradiologically supervised hospitals because the information they send raises questions.

Missing information can lead to misinterpretations. Bauknecht gives an example: A brightened area in the MRI could represent a tumor or an inflammation. The decisive factor is then complaints. If the patient has a fever and germs are circulating in his blood, it is more likely to be an inflammation.

Teleradiology companies, however, operate isolated from clinics. Inquiries are seldom made, says Galuszka from Teleradiology Europe. The Charité radiologist Bauknecht is not surprised. Communication stands and falls with the fact that you know each other. “I spend most of the day on the phone or stand with colleagues to discuss findings,” he says. "I always look at the recordings with the surgeon."

The images may be irrefutable, but their interpretation is not. For years, radiologists from the Charité have met weekly with attending physicians. Is the abnormality in the MRI a herniated disc or a relic of a previous operation? Sometimes opinions differ. “There is no such thing as absolute truth, which is why the exchange is so important,” says Bauknecht. "The focus is on the patient, not the picture."

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